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‫الصيدالني المتدرب على البرنامج السريري‬
‫حيدر عباس علي‬
‫دائرة صحة كربالء المقدسة‬
‫مستشفى النسائية والتوليد التعليمي‬
‫شعبه الصيدلة السريرية‬
Case of study :

A m is older female (41) years old , 73kg , she is married and

have 4 chilldren , presented with right iliac fossa pain for 1 day
duration on-off with once time vomiting , headache , pale ,
weakness.
Past medical history: no history.

History of surgery: ovarian cystectomy

Drugs allergy : negative

Pervious medication : no history

Subjective :

HR:82

BP: 120/80

SPO2: 95%

TEMP: 37.6
Objective :
Tests Results Normal values

RBC 3.9 106/UL 4.5 – 6.5

HCT 42.9 % 40 – 52
HGB 7.9 g/dl 13.5 – 17.5
WBC 16.9 103/UL 4 – 11.00
PLT 294 103/UL 155 – 450
MCV 68 75 -96
- Pelvic US : there is anechoic cystic lesion measures ( 51 mm * 55 mm ) at the
RT adnexa of clear fluid . (23/5/2022 )

After that

- pelvic US : irregular rapture cyst at RT measured of (34mm*31mm ) .

(24/5/2022
Problem list :

1. Polycystic ovarian syndrome

2. Anemia

Problem no 1 : PCOS

Subjective: right iliac fossa pain

Objective : Pelvic US : there is anechoic cystic lesion measures ( 51 mm * 55 mm ) at the RT
adnexa of clear fluid
ASSESSMENT :
Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women
of reproductive age. Women with PCOS may have infrequent or prolonged
menstrual periods or excess male hormone (androgen) levels. The ovaries may
develop numerous small collections of fluid (follicles) and fail to regularly release
eggs.
Polycystic ovary syndrome (PCOS) affects approximately 6% to 8%, or 1 in
15,women of reproductive age, making it the leading cause of anovulatory
infertility and the most common endocrine abnormality for this age group, patient
was recurrent pcos , she had surgical history of pcos , she was not taken any
treatment before for this problem , control for cyst very necessary by surgical
operation or treatment .
•Factors that might play a role include:
•Excess androgen: the ovaries produce abnormally high levels of androgen (male
hormone), resulting in hirsutism (excessive facial hair) and acne.
•Heredity: Research suggests that certain genes might be linked to PCOS.
•Excess insulin: Insulin is the hormone produced in the pancreas that allows cells to use
glucose - body's primary energy supply. If cells become resistant to the action of insulin,
then blood sugar levels can rise and body might produce more insulin.
•Low-grade inflammation: Research has shown that women with PCOS have a type of
low-grade inflammation that stimulates polycystic ovaries to produce androgens, which
can lead to heart and blood vessel problems.
PLANNING :
treatment goals in PCOS would include maintaining a normal
endometrium, blocking the actions of androgens at target tissues,
reducing insulin resistance and hyperinsulinemia, reducing weight, and
preventing long term complications.

Other goals of treatment in patients with PCOS may include correcting

anovulation or oligo-ovulation and improve fertility.
Also Several different pharmacologic options could be recommended to
pcos
A combined oral contraceptive (COC) will address her concerns about
irregular menstruation, hyperandrogenism, and pregnancy prevention.
An insulin sensitizer would improve her menstrual irregularity and
possibly reduce her hirsutism and acne, but it does not address her
desire to prevent pregnancy.
An antiandrogen, such as spironolactone, would address only
hyperandrogenism and other agents would
have to be used concurrently to address pregnancy prevention and the
other hormonal and metabolic alterations in PCOS
Problem no 2 : anemia
Subjective :
headache ,
weakness ,
pale ,
fatigue
Objective:
HGB : 7
MCV : 68
RBCs : 3.9
Assessment :

Anemia is a reduction in red blood cell (RBC) mass.

It often is described as a decrease in the number of RBCs per microliter (μL) or as a
decrease in the hemoglobin (Hgb) concentration in blood to a level below the normal
physiologic requirement for adequate tissue oxygenation

It is caused due to various reasons like:

1.Reduced production of red blood cells as in iron deficiency anemia or
megaloblastic anemia
2.Excess blood loss: blood loss can be due to external bleeding like in road traffic
accidents or internal bleeding as in hookworm infection, Excess bleeding during
periods (menstruation), long term use of drugs like aspirin or pain killers, etc
Also by
3.Destruction of the red blood cells: Hemolytic anemias
4.Autoimmune conditions like rheumatoid arthritis, systemic
lupus erythematosus, etc

patient was lack of feeding , she was not retreat any doctor for
her symptoms , she must take blood transfusion and supporting
by eating good food , the complication of anemia its very
dangerous on cardiac system ( cardiac diseases ) , and the
prevention of progression of anemia its very important .
Planning :
according the result of lab data patient have iron deficiency
anemia so must be started with blood transfusion to elevated
the value of RBC and HGB after that we can continue with
venofer amp on-off per day for 10 ampules or also we can
continue by oral route as table or oral liquid of iron with juice
40 mg Fe/day/20% absorption (approximate absorption rate in
iron-deficient states)
= 200 mg Fe/day
= 1,000 mg ferrous sulfate/day (ferrous sulfate contains 20%
elemental iron)
= 325 mg three times daily (TID) ferrous sulfate
RX in hospital //
 Claforan vial 1*2 ( diluted in 100 cc n/s and
administrated iv through 1 hr after making
sensitivity test of drug )
 Paracetamol vial 1000mg *2 ( administrated directly iv through 10-15 mint )
 Flagyl vial 500mg *2 ( diluted in 100 cc n/s and administrated iv through 1 hr after making
sensitivity test of drug )
 Ringer fluid 500 ml *2
 Blood transfusion
 Tramadol amp 1*2 im